Written by Laurence Amand-Eeckhout.
World Diabetes Day – marked every year on 14 November – was proclaimed by the United Nations in 2007 to raise awareness of diabetes and related complications, and to promote prevention and care, including through education. World Diabetes Day also offers an opportunity to evaluate progress in the EU.
Background
Diabetes is a chronic disease that occurs when the pancreas is no longer able to produce insulin, or when the body cannot make good use of the insulin it produces. Insulin helps glucose get into the cells. If the body is not able to produce insulin or use it effectively, the result can be raised blood glucose levels (hyperglycaemia), causing damage to the heart, blood vessels, eyes, kidneys, teeth and nerves. People with diabetes are also more likely to become severely ill if infected by the Covid-19 virus.
There are three main types of diabetes: type 1, type 2 and gestational. Type 1 results from a lack of insulin production and is diagnosed mainly in childhood and in teenagers. Its causes are still unknown (a genetic predisposition can exist, but the inheritance pattern is unknown). Daily insulin injections are required to keep blood glucose levels under control. Type 2, which accounts for 90 % of all diabetes cases, results from the body being unable to use the insulin it produces effectively. Type 2 is mainly diagnosed in adults, although an increase in cases has recently been observed among children. Type 2 diabetes often results from excess body weight and physical inactivity. A healthy lifestyle, regular physical activity and maintaining a normal body weight can help prevent type 2 diabetes. However, those who have already contracted type 2 diabetes require oral drugs and/or insulin to maintain safe blood glucose levels. Gestational diabetes consists of high blood glucose during pregnancy. Women affected and their children are at increased risk of developing type 2 diabetes later in life.
The theme for World Diabetes Day in 2021, the centenary of the discovery of insulin by Sir Frederik Banting and Charles Best at the University of Toronto, is ‘Access to Diabetes Care – If Not Now, When?‘.
Facts and figures
According to the International Diabetes Federation (IDF), approximately 463 million adults around the world were living with diabetes in 2019. This number is expected to rise to 700 million by 2045. The life expectancy of people living with diabetes is likely to be reduced as a result of their condition.
In the EU, over 32 million people were suffering from diabetes in 2019, with an additional 24.2 million people estimated to be undiagnosed.
The share of people reporting chronic diabetes varies between age groups, with the disease more likely to affect older people. According to Eurostat data for 2019, 18.5 % of people aged 65 to 74 in the EU reported chronic diabetes and a fifth (20 %) of those aged 75 or over, while the figure for age groups below 25 was under 1 %. Among the EU Member States, less than 5 % of the population aged 15 or over reported chronic diabetes in Ireland and Luxembourg. At the other end of the spectrum, in Croatia 12 % of the adult population were suffering from chronic diabetes, followed by Portugal (10 %) and Finland (9.5 %). The proportion of diabetics in the EU falls as educational level rises: while the percentage of people reporting chronic diabetes reached 10.8 % in 2019 among those with a low educational level, it was 6.8 % for those with a medium level of education and was even lower, at 4.1 %, among those best educated.
Direct costs relating to diabetes amounted to an estimated 9 % of total health expenditure in the EU in 2019, while diabetes can also result in indirect costs that are harder to measure, such as reduced work productivity.
EU action on diabetes
EU Member States are responsible for their own healthcare policies and systems. However, according to Article 168 of the Treaty on the Functioning of the European Union, EU action should complement national policies. The EU focuses on prevention, research, information and education, while also fostering cooperation between Member States.
The European Commission addresses diabetes in its work on non-communicable diseases (NCDs). It is supporting Member States as they work towards reaching the nine targets of the United Nations (UN) and World Health Organization on NCDs by 2025, as well as UN sustainable development goal 3.4, which aims to reduce premature mortality from NCDs by one third by 2030. To this end, in 2018 the Commission set up a steering group on health promotion, disease prevention and management of non-communicable diseases, which identifies best practices for dissemination and transfer between countries. As part of its efforts to build a European health union, on 11 November 2020 the Commission proposed a new health security framework that included a proposal to reinforce the mandate of the European Centre for Disease Prevention and Control (ECDC). On 14 September 2021, the European Parliament proposed that the ECDC’s mandate should cover not only communicable diseases, but also major non-communicable diseases such as diabetes, cancer, heart disease and mental illness. In the field of prevention, the Commission’s action focuses mainly on the key risk factors for type 2 diabetes, encouraging the promotion of healthy eating and physical activity and the reduction of obesity and the harmful use of tobacco and alcohol. The EU4Health programme, adopted in March 2021, will continue to provide funding for prevention during the 2021-2027 period. It will also support efforts to facilitate access to medicines and medical supplies, digitalise healthcare services, and set up a European health data space to promote the exchange of and access to various types of health data. Under the Horizon Europe research and innovation programme, the EU supports several projects geared towards preventing diabetes, improving treatment and translating new knowledge into innovative applications.
| MEPs Mobilising for Diabetes (MMD) The MEP Interest Group on Diabetes MMD, which is continuing the work of the EU Diabetes Working Group, was set up in 2020 and is co-chaired by Sirpa Pietikäinen (EPP, Finland) and Christel Schaldemose (S&D, Denmark). The group aims to foster EU policy action around a series of priorities: improving diabetes care and risk reduction; promoting better access to medicines and technologies; and eliminating discrimination against people living with diabetes. In February 2021, the group published a report ‘Blueprint for action on diabetes in the European Union by 2030‘, and held a webinar that discussed the priorities to be addressed in order to flatten the diabetes curve, improve the lives of people living with diabetes, reduce health inequalities and lessen the societal and financial burden for all. |
Challenges
Diabetes represents a growing threat in the EU. The ageing and increasingly overweight population, unhealthy diets and sedentary lifestyles are resulting in a rapidly increasing number of type 2 diabetes cases. Investment in prevention is essential to prevent diabetes through a healthy lifestyle starting in childhood. Education plays a significant role in preventing not just diabetes but also its complications. This involves a cross-sectoral policy response (relating to health, nutrition, education, mass media campaigns, social services, urban mobility, and physical and recreational activities).
Delivering better long-term care for patients living with diabetes means reducing significant disparities, both between and within Member States, so that all patients have access to quality medicines and medical devices at an affordable price. Investment in research (e.g. innovative tools and technologies, such as continuous glucose monitoring systems and new insulin delivery systems) and improved digitalisation of health services can improve patients’ quality of life and help to reduce health inequalities. To this end, in its own-initiative resolution of 25 March 2021 on a European strategy for data, the European Parliament considers it crucial to speed up the creation of a common European health data space, among other initiatives. This would, at the same time, help to reduce the economic burden for individuals, health systems and society at large.
Read this ‘at a glance’ on ‘World Diabetes Day 2021‘ in the Think Tank pages of the European Parliament.
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